Fat Embolism Treatment & Management

  • Author: Lisa Kirkland, MD, FACP, CNSP, MSHA; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Sep 8, 2011
 

Medical Care

Medical care for fat embolism is supportive in nature and includes maintenance of adequate oxygenation and ventilation, stable hemodynamics, blood products as clinically indicated, hydration, prophylaxis of deep venous thrombosis and stress-related gastrointestinal bleeding, and nutrition.

Continuous pulse oximetry monitoring in at-risk patients (ie, those patients with long bone fractures), may help in detecting desaturations early, allowing early oxygen therapy and possibly steroids, decreasing the chances of hypoxic insult and possible systemic complications of FES.[10]

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Surgical Care

Early stabilization of long bone fractures is recommended to minimize bone marrow embolization into the venous system. Rigid fixation within 24 hours has been shown to make a 5-fold reduction in the incidence of adult respiratory distress syndrome (ARDS).

  • Surgical technique, particularly of reaming or nailing the marrow, may help reduce the volume of fat embolization. However, a specific technique has not been identified.
  • Prophylactic placement of inferior vena cava filters may help reduce the volume of fat reaching the heart.
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Consultations

Depending on the mechanism of injury or insult, the specialists recommended to assist in management include orthopedists, neurologists/neurosurgeons, trauma care specialists, critical care specialists, pulmonologists, hematologists, and nutritionists.

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Contributor Information and Disclosures
Author

Lisa Kirkland, MD, FACP, CNSP, MSHA  Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard M Stillman†, MD, FACS  Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center

Richard M Stillman†, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Travis J Phifer, MD  Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport

Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

References

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  2. Metting Z, Rödiger LA, Regtien JG, van der Naalt J. Delayed coma in head injury: consider cerebral fat embolism. Clin Neurol Neurosurg. Sep 2009;111(7):597-600. [Medline].

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  9. Mimoz O, Edouard A, Beydon L, Quillard J, Verra F, Fleury J. Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism. Intensive Care Med. Dec 1995;21(12):973-80. [Medline].

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  18. Hofmann S, Hopf R, Huemer G, Kratochwill C, Koller-Strametz J, Schlag G. [Modified surgical technique for reduction of bone marrow spilling in cement-free hip endoprosthesis]. Orthopade. Apr 1995;24(2):130-7. [Medline].

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  23. Scully RE, Mark EJ, McNeely WF. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 23-1998. Tachypnea, changed mental status, and pancytopenia in an elderly man with treated lymphoma. N Engl J Med. Jul 23 1998;339(4):254-61. [Medline].

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Haematoxylin and eosin stain of a section of the lungs showing a blood vessel with fibrinoid material and an optical empty space indicative of the presence of lipid dissolved during the staining process. This 55-year-old woman died of massive fat embolism after developing pancreatitis due to endoscopic retrograde cholangiopancreaticography. Image source: Pancreatitis with an unusual fatal complication following endoscopic retrograde cholangiopancreaticography: a case report. Journal of Medical Case Reports. 2008;2:215.
Table 1
DoseModelTimingDuration of StudyEffect on Disease Incidence
30 mg/kgDogPre-event60 minNone
10 mg/kg q8h for 24 hHuman traumaAt admissionNo dataDeclining
7.5 mg/kg q6h for 12 h or placeboHuman traumaWithin 12 h2 dDeclining
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